August 2005

Medical Staff Bulletin

Message from the Chief of Staff

Most members of the Yale-New Haven Hospital medical staff have learned by now that Marna P. Borgstrom, executive vice president and chief operating officer of Yale-New Haven Hospital, has been selected to serve as president and chief executive office of Yale-New Haven Hospital and Yale New Haven Health System. The board of trustees of Yale-New Haven Hospital and the board of directors of Yale New Haven Health System jointly made this appointment on July 27, 2005, effective October 1, 2005.

Mrs. Borgstrom's appointment culminated a national search process that was initiated in May 2005. Eleven members of the hospital and system boards served as the Search/Selection Committee. The firm of Spencer Stuart was chosen as the Search Committee's consultant and Spencer Stuart, in preparation for the search, interviewed more than 40 individuals from the Yale School of Medicine, Yale-New Haven Hospital, Yale New Haven Health System, and the medical staff. A position description and candidate specification was developed as a result of these interviews. Thereafter, recruiting efforts were targeted to 44 academic medical centers and 33 medical schools in the U.S. Thirteen highly qualified and interested executives and leaders were identified and five were interviewed one or more times. The three finalists included Mrs. Borgstrom and two external candidates. Ultimately, the Selection/Search Committee unanimously endorsed Mrs. Borgstrom's candidacy.

Mrs. Borgstrom came to Yale-New Haven Hospital as an administrative resident in 1979, after receiving her undergraduate degree at Stanford University and her MPH at Yale. She rose to the vice president level in just six years and has been EVP/COO for the last 12 years. She has managed Yale-New Haven Hospital with insight, sensitivity, and extraordinary commitment to our highly diverse constituents. She has been a true friend of the medical staff and we congratulate and welcome her to the most senior leadership position in our great hospital.

Paperless inpatient laboratory reporting

Diagnostic Imaging and Laboratory results reporting are now well established in our new clinical information system, Sunrise Clinical Manager (SCM). Moreover, SCM is effectively backed up by MD Link on our clinical work stations and by Direct Laboratory Access at specified computer terminals. About one year ago, the Medical Record Committee approved elimination of daily printing of laboratory reports, acknowledging that these are not only rarely consulted, but impossible to keep as current as the electronic laboratory records. On August 16, 2005, we began "weaning" Yale-New Haven Hospital from these printed reports, beginning with pilot units that included Newborn Special Care, the Neurosciences Intensive Care Unit, the Cardiothoracic Intensive Care and Step-down Unit (EP 4-7), Gynecologic Oncology (8WP) and EP units 7-5 and 10-7. Cessation on other units will shortly follow. (The complete laboratory report will still be printed in the final medical record.) We are indebted to Dr. Marie-Louse Landry for shepherding this process. Issues or concerns related to this transition should be directed to Dr. Peter Herbert at (203) 688-2604.

Performance management update

Following are Yale-New Haven Hospital's April performance statistics for the measures we report to Medicare and JCAHO each month. You are now well aware that our goal for 2005 is to exceed the national 90th percentile for every measure, and we continue to make progress toward that goal.

One specific area that requires additional effort involves the discharge process. At least three measures surrounding the discharge process, ACE/ARB use in CHF and in acute MI with left ventricular dysfunction, and discharge instructions in patients with CHF, are lagging below our goals. We also hear from patient comments that other elements of the discharge process could be improved, so a renewed effort will shortly begin combining the energies of nursing, care coordination and the medical staff.

As previously noted, we will be sending reminder notes to the physician attending of record for patients who have no documentation of discharge instructions, or who have failed to receive appropriate medications at discharge (or documentation of why the medication was not indicated). Many thanks to all those whose hard work has benefited our patients, as evidenced by the improvement in our measures. If you have any questions, please call Dr Tom Balcezak at (203) 688-1343.

April 2005 Performance

North Pavilion/Cancer Center update

The Office of Health Care Access held a public hearing about Yale-New Haven Hospital's proposed cancer center on June 13, at which over 120 citizens - including approximately 110 in favor of the cancer center - testified. On June 29, OHCA held the mandated technical hearing at which the hospital and medical staff effectively presented the case for the additional beds and the construction of the clinical cancer center. The city process was formally initiated with four public hearings during July primarily focused on zoning and the easements necessary to build the cancer center. Design documents are complete and the architects have completed 75 percent of the construction drawings for the cancer center. With state approval anticipated in early September and city approval anticipated in October, the cancer center should be started in late 2005 or early 2006. The overall length of construction is approximately 36 months.

2005 Residency match

For the 2005 United States Medical Graduate (USMG) and residency match, Yale-New Haven Hospital listed 1,584 applicants for 173 residency positions and filled all in the match but a single preliminary position in Internal Medicine. Of these, 90 (52%) were women. In the early match, which included Ophthalmology, Neurology, Neurosurgery, Urology and ENT, Yale-New Haven Hospital filled all 16 positions. Yale-New Haven Hospital's 2005 house staff are coming from 75 U.S. medical colleges, including 25 from the Yale University School of Medicine and 22 from New York City schools.

National trends evident over the last five years have continued. Only about 65% of all residency positions offered are filled by U.S. medical graduates and 27% by international graduates. The adult primary care specialties continue to attract disproportionately fewer American graduates: Family Practice (40 %), Internal Medicine (55%), and Primary Care Internal Medicine (59%). Pediatrics (74%) and Medicine-Pediatrics (70%) do better attracting graduates of U.S. schools. General Surgery (80 %) and Orthopedic Surgery (92%) are more competitive than Obstetrics and gynecology (67%). OB/GYN filled with 74% American grads in 2001 and most agree that medical liability insurance premiums have disadvantaged this specialty.

Refer items for the next issue of Medical Staff Bulletin via phone, fax, e-mail or mail to:
Peter N. Herbert, MD
1063 Clinic Building
P: (203) 688-2604, F: (203) 688-7152
herbertpn@ynhh.org
or
Katie Murphy
Marketing & Communications
GB 443
P: (203) 688-2492, F: (203) 688-2491
Katie.Murphy@ynhh.org

Back issues of the Medical Staff Bulletin:

• June 2005
• March 2005
• January 2005
• December 2004
• November 2004
• October 2004
• September 2004
• July 2004
• June 2004
• May 2004
• April 2004
• March 2004
• February 2004
• January 2004
• January/February 2003
• October/November 2002
• August/September 2002
• April/May 2002
• February/March 2002
• January 2002
• November 2001
• July/August 2001

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Last revised: September 8, 2005 (mv)

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All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.